N-acetylcysteine as adjunctive treatment in severe malaria: a randomized, double-blinded placebo-controlled clinical trial.
N-acetylcysteine as adjunctive treatment in severe malaria: a randomized, double-blinded placebo-controlled clinical trial.
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DOI：
10.1097/ccm.0b013e3181958dfd
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发表时间：
2009-02
影响因子：
8.8
通讯作者：
Dondorp AM
中科院分区：
文献类型：
--
作者：
Charunwatthana P;Abul Faiz M;Ruangveerayut R;Maude RJ;Rahman MR;Roberts LJ 2nd;Moore K;Bin Yunus E;Hoque MG;Hasan MU;Lee SJ;Pukrittayakamee S;Newton PN;White NJ;Day NP;Dondorp AM
据报道，严重疟疾患者的氧化应激标志物增加。有研究表明，抗氧化剂N-乙酰半胱氨酸(NAC)在治疗中可能是有益的。我们研究了N-乙酰半胱氨酸作为青蒿琥酯辅助治疗重度恶性疟疾的有效性和安全性。青蒿琥酯大剂量静脉注射NAC辅助治疗的随机、双盲、安慰剂对照试验。泰国西部的一家省级医院和孟加拉国吉大港的一家三级转诊医院。108例成人重度恶性疟疾患者。患者随机接受N-乙酰半胱氨酸或安慰剂作为青蒿琥酯静脉注射的辅助治疗。共有56名患者接受NAC治疗，52名患者接受安慰剂治疗。NAC对死亡率、乳酸清除时间(p=0.74)或昏迷恢复时间(p=0.46)没有显著影响。寄生虫清除时间从30h(6h~144h)增加到36h(6h~120h)(p=0.03)，但这可以用入院寄生虫血症的差异来解释。与无并发症的疟疾患者和健康志愿者相比，重度疟疾患者的尿中F2-异前列腺素代谢产物(作为氧化应激的标志)增加。入院时红细胞刚性与死亡率相关，但与NAC无关。严重疟疾患者全身性氧化应激增加。在这种情况下，N-乙酰半胱氨酸治疗对严重恶性疟疾患者的预后没有影响。
Markers of oxidative stress are reported to be increased in severe malaria. It has been suggested that the antioxidant N-acetylcysteine (NAC) may be beneficial in treatment. We studied the efficacy and safety of parenteral N-acetylcysteine as an adjunct to artesunate treatment of severe falciparum malaria. A randomized double-blind placebo controlled trial on the use of high dose intravenous NAC as adjunctive treatment to artesunate. A provincial hospital in Western Thailand and a tertiary referral hospital in Chittagong, Bangladesh. One hundred and eight adult patients with severe falciparum malaria. Patients were randomized to receive N-acetylcysteine or placebo as adjunctive treatment to intravenous artesunate. A total of 56 patients were treated with NAC and 52 received placebo. NAC had no significant effect on mortality, lactate clearance times (p=0.74) or coma recovery times (p=0.46). Parasite clearance time was increased from 30h (range 6h to 144h) to 36h (range 6h to 120h) (p=0.03), but this could be explained by differences in admission parasitemia. Urinary F2-isoprostane metabolites, measured as a marker of oxidative stress, were increased in severe malaria compared to patients with uncomplicated malaria and healthy volunteers. Admission red cell rigidity correlated with mortality, but did not improve with NAC. Systemic oxidative stress is increased in severe malaria. Treatment with N-acetylcysteine had no effect on outcome in patients with severe falciparum malaria in this setting.